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Optimization of BMI-Based Images for Overweight and Obese Patients — Implications on Image Quality, Quantification, and Radiation Dose in Whole Body 18F-FDG PET/CT Imaging

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Abstract  

Purpose

In PET/CT imaging, the activity of the 18F-FDG activity is injected either based on patient body weight (BW) or body mass index (BMI). The purpose of this study was to optimise BMI-based whole body 18F-FDG PET images obtained from overweight and obese patients and assess their image quality, quantitative value and radiation dose in comparison to BW-based images.

Methods

The NEMA-IEC-body phantom was scanned using the mCT 128-slice scanner. The spheres and background were filed with F-18 activity. Spheres-to-background ratio was 4:1. Data was reconstructed using the OSEM-TOF-PSF routine reconstruction. The optimization was performed by varying number of iterations and subsets, filter’s size and type, and matrix size. The optimized reconstruction was applied to 17 patients’ datasets. The optimized BMI-, routine BMI- and the BW-based images were compared visually and using contrast-to-noise ratio (CNR) and standardized uptake values (SUV) measurements.

Results

The visual assessment of the optimized phantom images showed better image quality and contrast-recovery-coefficients (CRCs) values compared to the routine reconstruction. Using patient data, the optimized BMI-based images provided better image quality compared to BW-based images in 87.5% of the overweight cases and 66.7% for obese cases. The optimized BMI-based images resulted in more than 50% reduction of radiation dose. No significant differences were found between the three series of images in SUV measurements.

Conclusion

The optimized BMI-based approach using 1 iteration, 21 subsets, and 3 mm Hamming filter improves image quality, reduces radiation dose, and provides, at least, similar quantification compared to the BW-based approach for overweight and obese patients.

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Data Availability

The datasets generated during and/or analysed during the current study are available in our local PACS storage system.

Code Availability

The Siemens Syngo.via reporting and processing workstation was used.

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Authors and Affiliations

  1. Sultan Qaboos University, College of Medicine and Health Sciences, Radiology and Molecular Imaging, Muscat, Oman

    Yassine Bouchareb

  2. Sultan Qaboos University Hospital, Radiology and Molecular Imaging, Muscat, Oman

    Naima Tag, Zabah Jawa & Humoud Al-Dhuhli

  3. Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman

    Hajir Sulaiman & Khulood Al-Riyami

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Contributions

The study conception and design were performed by Yassine Bouchareb and Naima Tag. Material preparation, data collection and analysis were performed by Yassine Bouchareb, Hajir Sulaiman and Naima Tag. The assessment of phantom and clinical images was carried out by Naima Tag, Khulood Al-Riyami and Zabah Jawa. The first draft of the manuscript was written by Yassine Bouchareb and Hajir Sulaiman and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yassine Bouchareb.

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Conflict of Interest

Yassine Bouchareb, Naima Tag, Hajir Sulaiman, Khulood Al-Riyami, Zabah Jawa, and Humoud Al-Dhuhli declare that they have no conflict of interest.

Ethics Approval and Consent to Participate

The study was approved by the Research Ethics Committee of college of medicine and health sciences, Sultan Qaboos University (ethics approval certificate can be sent upon request). As per the policy of our institution, the ethical approval of retrospective studies grants the use of patients’ data in clinical research projects (no consent to participate is required). Patients’ scans used in the study were part of the routine care, and were in accordance with the Helsinki declaration as revised in 2013 and its later amendments.

Consent for Publication

As per the policy of our institution, the ethical approval of retrospective studies grants the use of non-identifiable patients’ data in papers for publication.

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Bouchareb, Y., Tag, N., Sulaiman, H. et al. Optimization of BMI-Based Images for Overweight and Obese Patients — Implications on Image Quality, Quantification, and Radiation Dose in Whole Body 18F-FDG PET/CT Imaging. Nucl Med Mol Imaging 57, 180–193 (2023). https://doi.org/10.1007/s13139-023-00795-5

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